Provider Demographics
NPI:1225327281
Name:MATSUMORI, DEVIN T (DDS)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:T
Last Name:MATSUMORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 9400 S STE 110
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3689
Mailing Address - Country:US
Mailing Address - Phone:801-571-8391
Mailing Address - Fax:
Practice Address - Street 1:870 E 9400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3666
Practice Address - Country:US
Practice Address - Phone:801-571-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081501223G0001X
UT7987460-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice